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2012
March
P
Pilot Program Survey
Pilot Program Survey
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Hello:
You has been invited to participate in this survey. The survey is designed to gather information about how you manage your money.
Your survey responses will be strictly confidential and data from this research will be not be shared with any third parties.
The survey will take approximately 5 minutes to complete.
Thank you very much for your time and support. Please start with the survey now by clicking on the
Continue
button below.
Contact Information
First Name
:
Last Name
:
Address 1
:
Address 2
:
City
:
State
:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
District of Columbia
Zip
:
Phone
:
Email Address
:
Annual Income:
*
Age:
-- Select --
18 - 21
22 - 34
35 - 44
45 - 54
55 - 64
65 and older
*
Martial Status:
-- Select --
Single
Married/Remarried
Divorced
Widowed
Civil Union/Domestic Partnership
Other
*
How often do you pay bills?
-- Select --
Weekly
Bi-Monthly
Monthly
When they are due
*
How do you manage your budget?
-- Select --
Budget? I don't have a budget.
Pencil & Paper
Professional Service
Spreadsheet
Software
*
Would you use a professional money management service?
Yes
No
I haven't given it much thought
If so, how would you prefer to receive service?
-- Select --
Business Office
Personal Residence
Online
Phone
Other
*
Are you interested in participating in trail money management service?
Yes
No
Maybe
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